Healthcare Provider Details

I. General information

NPI: 1386978641
Provider Name (Legal Business Name): LENAN RUST ATR-BC, LPCC, LPAT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2009
Last Update Date: 09/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 HERMOSA DR SE
ALBUQUERQUE NM
87108-4312
US

IV. Provider business mailing address

212 JEFFERSON ST NE APT A
ALBUQUERQUE NM
87108-1313
US

V. Phone/Fax

Practice location:
  • Phone: 505-266-7711
  • Fax:
Mailing address:
  • Phone: 505-266-7711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPCC 0104491
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPAT 1046
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: